Mr. Kitchens:Artia
Solutions is a consulting firm based in Tallahassee, Florida, that
specializes in assisting pharmaceutical companies in managing their U.S.
Medicaid, VA/DoD, and Puerto Rico Medicaid business. We assist our clients
in new drug launches by determining if they should be providing rebates for
their drugs, and we also assist with any issue resolution that may impact
access. We also provide guidance and operational help in both protecting and
promoting access of their medications within the Medicaid marketplace.

CEOCFO:
What are some of the lesser known challenges in the Medicaid market?

Mr. Kitchens:
The complexity of Medicaid is what challenges every pharmaceutical company.
All 50 states are different. There is a saying that goes: “If you have seen
one state, you have seen one state.” Companies can either quickly expend too
many resources when managing their Medicaid business, or they can
underestimate the impact of working with Medicaid (i.e., how their drug
status within Medicaid influences overall physician prescribing).

We have seen
people on both sides—pharmaceutical companies and payers—not understanding
their opportunity in Medicaid. Some underestimate the complexity by
expending time and resources in certain states or areas when it was not
necessary. Medicaid is a low-profit opportunity for pharmaceutical
companies, but it is a necessary business to engage. Companies have to
engage it wisely and be efficient in their processes if they want to
participate in Medicaid. From cost perspective to the federal and state
government’s influence and all of its nuances, it’s all crucial to
understand so that Medicaid patients have access to medications.

It can also
be challenging for the payers to have a comprehensive understanding of the
value of the medication. The recent introduction of several expensive
medications has many people focusing on pharmaceutical cost, while
overlooking cost savings related to supportive help, provider costs, and
even societal costs. Drugs that are now curing conditions add a new
perspective to the value equation: durability. The status quo for coverage,
reimbursement, and the determination of the overall value statement are now
being challenged. There are no more quick fixes. Solutions will require
multi-disciplinary teams that represent all major stakeholders. There is a
bit of a conflict happening now where some still want to operate in the old
system, and they may think they can take quick shortcuts in problem-solving.
But that must change. At Artia Solutions, we help both pharmaceutical
companies and payers understand the true value of the medication.

CEOCFO:
How do you decide when the overall assessment is borderline?

Mr. Kitchens:
When we have a “borderline” assessment, we do not know exactly how every
drug is going to work in every patient. You and I are physiologically
different. What may be beneficial or borderline beneficial for some patients
(in a clinical study) may be different in the real world. We still need to
allow physicians who know each patient and know the complexity of what they
are dealing with, such as co-morbidities, etc., to say, “I think this drug
has potential to be beneficial.” Therefore, a borderline could be beneficial
to some patients. We have to be sensitive to that side of the equation, too.

CEOCFO:
Are there many companies that specialize in this arena?

Mr. Kitchens:
No—not to the level that we do. Not only do we provide strategic consulting
and forecasting of access to their medications, but we are also operational.
We are proactive, we talk with the states and the PBMs (Pharmacy Benefit
Managers), and we help pharmaceutical companies position their drug so that
the various state Medicaid can understand the value and financial
information. Many of our clients appreciate that we live and breathe this
work every day. We are working alongside them, and that provides a high
level of confidence for us to say, “Here is what is going to happen,” or
“here is what we predict your forecast will be.” We are confident in our
consulting because we are working within it day-in and day-out.

CEOCFO: Do
you have companies that routinely come to Artia Solutions when working on a
new drug?

Mr. Kitchens:
Yes. We have been in this industry for almost two decades, and we have
gained the trust and confidence of the pharmaceutical industry. We are
well-known because of the work we have done in the past and the results we
continue to produce. There is a difference between someone telling a client:
“Here is what Medicaid will do or will not do,” versus “This is how Medicaid
works because we were just in a similar situation.” We provide the latter.
We work alongside our clients as they begin to implement a new drug
strategy. We are right there with our clients as long as they want us to be.
Remember—there is not a lot of profit in Medicaid. Companies have to be
extremely cost-effective, and they cannot dedicate a large staff to manage
their Medicaid business. We help them to be targeted and effective. We do
this every day—we complement our clients’ staff, fill in any gaps, and do
the work that’s needed as they are trying to control their costs.

CEOCFO:
How do you stay on top of not only the regulations in a given state but of
the sentiment that might be leading to a change?

Mr. Kitchens:
Several of the Artia Solutions staff are former Medicaid officials, but we
don’t just rely on past experience. We are well-connected around the country
with people whom I would consider to be thought leaders, and many are my
former peers or people I have known for years. We converse with the states
and the PBMs on a daily basis because gaining insight on their perspective
is key. Not just insight on an individual drug—it could be their situation,
or what they believe the states are wanting. Sometimes, their view is very
different from what I see from my view, so it is helpful that we have these
conversations. They don’t only understand the nitty-gritty detail on the
state of the industry today, but they also are forecasting what the next two
to five years may look like. Through these types of conversations, our daily
work, listening to people in Washington and several lobbying firms that are
knowledgeable and helpful, etc., we’ve created a network of people we trust.
I’m thankful that I continue to learn something new every day.

CEOCFO:
You offer a variety of services. Is it typically soup to nuts?

Mr. Kitchens:
Our services are customized for each client, and many of our clients use our
services from beginning to end because they find that it is an efficient way
to measure a successful Medicaid business. Some of our clients have a small
staff and need all of our services in order to manage their Medicaid or VA/DoD
business. Some have a large staff and may only need a few services, but many
of our clients expand their services over time. For example, a client may
use our monitoring services daily but soon realize they need to add on our
mobile app, the ARTIA app, for even more updates and information. When we
begin our services with a new client, our first few conversations revolve
around discovering what their needs are. We build a customizable and
flexible plan for every client.

CEOCFO:
Does a drug have to be available in all states when it becomes available?

Mr. Kitchens:
Once a drug manufacturer has decided to participate in Medicaid and signed
the CMS rebate agreement, the drug is technically covered in all states.
However, the variances in access are impacted by utilization tools, such as
Preferred Drug List status, new drug policy, and clinical prior
authorizations.

CEOCFO:
Are Medicaid requirements stricter than a Medicare program?

Mr. Kitchens:
An outsider looking in may think Medicaid is more liberal, due to some of
its more well-known policies and CMS rebates. However, the states are
allowed to use different drug management tools to ensure that a particular
drug is used properly and that there is not misuse and abuse or overuse—just
like in a commercial plan or Medicare. It’s important to note that people
typically only hear the gross cost—before rebates are paid—of drugs in
Medicaid, and they’re alarmed. The rebates that are given to the states by
the manufacturers are significant, and those rebates end up in the lower net
cost, as compared to a commercial plan or Medicare D plan, and this dictates
different decision-making. One may look at a Medicaid formulary (we call
them “preferred drug business”) and think: “Wow. They have a lot of brands,
and they’re not doing a good job of controlling their cost.” The reality is
those brand drugs are much less costly than generics. The states are going a
good job of controlling their drug cost. There is a huge disconnect in
public perception. With rebates, Medicaid recipients typically have better
access to brand drugs, compared to a commercial plan, because the net cost
of brand drugs is less than generics.

CEOCFO:
The tagline on your website is Consult, Guide, and Connect. Would you
explain the Connect?

Mr. Kitchens:
An important part of our business is the relationships we have with the drug
manufacturers and the states. Many state pharmacy directors were my former
peers, along with some of my staff members, so we assist in connecting the
two. We set up meetings; we attend meetings with them in-person; we make
phone calls. We are actively involved in making sure our clients are talking
to or meeting with the right people at the right time. We take the lead and
participate in this connection, if that is what our client requests.

CEOCFO:
How is business?

Mr. Kitchens:
Great! I have been in business for 13 years, and I have been blessed with a
wonderful staff. When I just started out as a pharmacist who graduated from
Samford University, I never would have thought that I could look back at my
career and be amazed at where we are. I’m grateful for this business and the
people I get to work with every day. I can say the same about working with
the states and the PBMs—there are great people in this industry, and the job
is very satisfying. It’s also amazing to see the groundbreaking work in the
area of pharmaceuticals—gene therapy, biosimilars, etc. We’ve also recently
announced our inaugural Medicaid conference, Crossroads, which will take
place in Nashville, Tennessee, in November. We’re excited to bring together
stakeholders from every side of the pharmaceutical industry to discuss
patient access to medications. Crossroads will be the first event of its
kind in this industry.

CEOCFO:
Why is Artia Solutions an important company?

Mr. Kitchens:
In today’s environment, you cannot afford a misstep in any particular
business venture, especially in one as complex as Medicaid. Artia Solutions
is there to assist, consult, guide and connect pharmaceutical companies and
ensure they are maximizing their Medicaid business opportunity.

“In today’s environment, you cannot afford a misstep in any particular
business venture, especially in one as complex as Medicaid. Artia Solutions
is there to assist, consult, guide and connect pharmaceutical companies and
ensure they are maximizing their Medicaid business opportunity.”
- George
Kitchens, RPh